NPIMap

Organization Active NPI

Panda Bear Pediatrics

  • Pediatrics Physician
  • Collegeville, PA
National Provider Identifier
1497788327
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OS-009162L Issued in PA
Legal business name
PANDA BEAR PEDIATRICS
Practice address
555 South Second Avenue
Building B, Suite 200
Collegeville, PA 19426-2854
Phone
(610) 409-8050
Fax
(610) 409-8075
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Larissa F Dominy, D.O.NPI 1376575282
Title
Physician/Managing Member
Phone
(610) 409-8050

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X OS-009162L PA Primary

Addresses

Primary practice location

555 South Second Avenue
Building B, Suite 200
Collegeville, PA 19426-2854

Mailing address

102 Shetland Way
Collegeville, PA 19426-2854
Phone (610) 409-8050

National Provider Directory

National Provider Directory

Locations

409 Second Ave
Ste 303
Collegeville, PA 19426
Phone (610) 409-8050

555 Second Ave
Ste B-200
Collegeville, PA 19426
Phone (484) 854-1317

1831 Swamp Pike
Ste 202
Gilbertsville, PA 19525
Phone (610) 323-5415

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497788327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 SHETLAND WAY",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262854",
            "telephone_number": "610-409-8050",
            "fax_number": "610-409-8075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SOUTH SECOND AVENUE",
            "address_2": "BUILDING B, SUITE 200",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194262854",
            "telephone_number": "610-409-8050",
            "fax_number": "610-409-8075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANDA BEAR PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOMINY",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PHYSICIAN/MANAGING MEMBER",
        "authorized_official_telephone_number": "610-409-8050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "OS-009162L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collegeville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.